Recent Improvements in Anesthetic Techniques for Use during Bronchoscopy

Abstract

Bronchoscopy usually necessitates anesthesia in order for it to be performed without excessive patient discomfort. Bronchoscopy with the rigid bronchoscope under local anesthesia is the more unpleasant but causes normal or lower than normal arterial CO2 levels with normal or increased arterial O2 levels. General anesthetic techniques for use with the rigid bronchoscope have improved markedly in recent years. At present three ventilation techniques seem safe: the Sanders' venturi, Carden sidearm injector and Komessaroff bronchoflator systems. These techniques can be expected to deliver adequate ventilation and oxygenation (Sanders system) to very good ventilation with much higher arterial oxygen levels (the Carden and Komessaroff systems). These techniques involve thiopental and succinylcholine for anesthesia; an oxygen/nitrous oxide blender added to the Carden sidearm system enables balanced anesthesia to be used, which is a decided advantage. Bronchofibroscopy is a new art which can be performed with relatively little patient discomfort under local anesthesia but at the risk of lowering the arterial oxygen tension. Added oxygen should be used but preferably not down the instrument itself. Under general anesthesia bronchofibroscopy has been performed, but ventilation of the patient is often impaired unless a large endotracheal tube is used for passage of the instrument.